Os autores relatam um caso de metástases cerebrais de corioepitelioma em paciente de 30 anos de idade, internada por apresentar um tumor abdominal, amenorréia e cefaléia. O diagnóstico inicial fôra de gravidez normal e neoplasia do trato digestivo. Após breve revisão da literatura são comentadas as repercussões neurológicas deste tipo de neoplasia.

A case of cerebral metastatic chorionepithelioma, with post-mortem examination in a 30 years old female patient having an abdominal tumor, amenorrhea and headache is reported. The initial diagnosis was that of normal pregnancy and neoplasm of the digestive tract. A review of the literature is made and the neurological repercussion of this tumor is discussed.

São analisados os resultados eletrencefalográficos de 700 crianças, com idade de 0 a 6 anos, que apresentaram convulsões isoladas, sem história ou manifestações clínicas de qualquer outra moléstia. Os resultados nos subgrupos de pacientes com convulsões febrise não febrissão analisados separadamente sob o ponto de vista estatístico, assim como nos subgrupos de 0-2 e 3-6 anos de idade. Análise similar foi feita nos subgrupos de pacientes examinados somente durante o sono ou em sono e em vigília, com finalidade de testar o fator técnico do exame. Deste estudo podem ser tiradas três conclusões principais: 1) nas crianças com convulsões isoladas aparecem sinais eletrencefalográficos que permitem diagnóstico da existência de lesão cerebral em uma incidência estatisticamente significante; 2) a incidência de lesões cerebrais focais nos casos de convulsões não febrisé também significativamente maior que nos casos de convulsões febris, oque sugere que as convulsões nesses grupos de pacientes dependem de condições cerebrais diferentes; 3) no estudo eletrencefalográfico das crianças com convulsões, deve ser tomado em consi- deração se o exame foi feito somente durante o sono ou se também em vigília, pois tais resultados não podem ser considerados em conjunto, sob pena de se incorrer em erro grosseiro.

The electroencephalographic records of 700 children, up to 6 years old, with a history of only convulsions without other clinical manifestations are analysed. The EEG findings in patients with febrileand non febrile convulsions,in waking and sleeping state and according to their age (0-2 and 3-6 years old), were compared statistically. From this study three main conclusions can be drawn: 1) there is a significant percentage of cerebral abnormalities among the children with isolated convulsions; 2) there is a significantly higher incidence of focal abnormalities in patients with non febrile convulsionsthan in those with febrile convulsions,suggesting that convulsions in each group may correspond to different cerebral conditions; 3) in the electroencephalographic study of these children with convulsions one must take into account the state of the patient during the recording (awake or asleep). It would be an error to consider results as they were of a homogeneous group.

In the past few years somewhat new yet often differing points of view have been affirmed refering to Petit Mal epilepsy, with regard to its clinical, eletrencephalographic and evolutive aspects. The classical concept of PM epilepsy as established by Lennox and Gibbs, with its well defined clinical and EEGraphic characteristics is continually being modified with new research work on clinical and EEGraphic aspects. Numerous clinical cases have been published whose evolution clashes with that classically described and likewise numerous are those cases where the EEG shows signs of focal electric activity besides spike and wave dis-rythmia. Cases have been known where surgical exerese on the focus causes temporary desappearance of the spike and wave disrythmia. The present concept now holding sway is that PM epilepsy is a kind of reaction of infantile encephalon to diverse harmful causes. From this it will be seen we are very far from the concept that PM epilepsy is a pure form of idiopathic epilepsy. For these reasons we decided to re-examine those cases observed between 1950 and 1960. With this in mind we chose 141 PM epilepsy cases, from among over 23000 epileptics, all examined under a standard criterion by a small group of senior assistants. All cases suspected of Psm epilepsy were excluded. The analysis of this group of patients was compared to that of another group with GM as well as PM seizures (104 patients); in 52 of these cases, studies were made concerning the evolutive, clinical and EEGra-phic aspects. METHOD: Clinical criterion was used for selection of the cases. The results of the analysis from the clinical and EEGraphic point of view were exhibited in demonstrative graphs. From the clinical point of view we strove to find out positive hereditary elements, organic cerebral injury factor (intellectual deficit, mood and behaviour disturbances, neurologic or somatic signs, as well as other development anomalies), the presence of febrile convulsions before the setting in of clinical PM syndrome and the eventuality of abnormal birth. We listed the patients according to their sex and investigated the statement that there is a prevalence of PM seizures among women. We attempted to analyse the incidence of cases according to the patient's age, as well as the incidence regarding the onset age of the illness. With regard to the EEG we likewise attempted to analyse those elements enabling us to weigh up the lesional factors in the brain (abnormalities in the background activity, disrythmias with focal characteristics or other paroxysmal abnormalities of a lesional type) and the bilateral and synchronous paroxysmal disrythmias classically known as forming part of the Petit Mal epileptic picture. Out the group of patients presenting pure PM seizures (141 cases) we obtained a clinical and EEGraphic sequence in 37, during a period of time ranging from 1 to 13 years. Of the group of patients presenting GM seizures as well as PM (104 patients) we investigated, in a comparative manner, 15 cases in a cliincal and EEGraphic sequence, during a period ranging from 1 to 9 years. RESULTS: The analysis of the clinical and electroencephalographic aspects in the first group of patients (141 cases with PM seizures) has enabled us to point out - a) A greater occurrence of this disease between the ages 6 and 12 - though there were 48 patients between the ages of 11 and 20 and 16 patients above 20 years old; b) in the majority of cases the disease set in between the age of 6 and 10 (47 cases); in some cases however the disease started up under two years of age; in 31 patients the onset was after 11 years of age; c) as far as sex distribution, there was no significant difference; d) barely 1 case proved to be abnormal in the somatic examination congenital cardiopathy) ; e) the occurrence of psychic disturbances among patients was extremely low; f) there were no cases with past history of abnormal birth; g) back-ground activity was with in the limits of normality in the great majority of cases; h) incidence of bilateral and synchronous spike and wave 3 c/s, was fairly high; slower disrythmia of this type was present in 4 cases only; i) larval disrythmias by spikes or multiple-spikes and slow ware occurred quite often and appeared both in the mioclonic form of PM as well as in the other forms of the disease; j) diffuse and irregular slow sharp waves, were found in 7 patients and sharp focal waves in 4; these alterations would always seem to appear associated with bilateral and synchronous disrythmias. The analysis of these same elements in the second group (104 patients with PM plus GM seizures) has enabled us to note the following details: a) later age of onset; b) in 5 cases there was child-birth asphyxia; c) higher incidence of cases presenting bilateral and synchronous disrythmias with a frequency below 3 c/s. The development aspects of our patients was not uninteresting. Out of 37 patients with pure PM seizures we noted: a) that the age of onset did not on the whole favour or unfavour the evolution; b) the great majority of cases developed favorably: 18 patients have no more seizures, 11 still present a very minimum number of seizures; 6 later had GM seizures associated; one patient showed a rather serious impairment of his seizures; c) in cases of favorable development,' synchronous disrythmias by spike and wave 3 c/s disappeared, which was not what happened in the group of cases showing unfavorable development; d) total disappearance of disrythmias was only noted in those cases of favorable development; e) there were cases, both among the favorable and unfavorable development groups, where the initial disrythmias perceptibly modified with time and became diffuse sharp waves; f) background activity was normal in the great majority of cases; g) some of our patients developed with clinical fits even over the age of 30. Out of 15 patients with GM plus PM seizures and on whom development studies were made, we noted that the results differed very little from those of the previous group. We should like to point out, however, that disappearance of the spike and wave 3 c/s disrythmias did not occur, even in those cases presenting favorable clinical development. COMMENTS: After discussing the most interesting facts stated in the analysis of their cases and co-relating them to litterature data found, with particular reference to the works presented at the Congress of Brussels by Jung, Bickford, Droogleever-Fortuyn, Gibbs and Walker, the AA have come to the following conclusions: 1) there are clinical and electroence-phalographic indications that the syndrome "Petit Mal Epilepsy" is a clinical manifestation of diverse brain affections; 2) the starting up of the Petit Mal syndrome occurred at an age below 11 years in the majority of cases; however, there are others where the onset occurred after this age and in some cases even above the age of 20; 3) the persistence of Petit Mal clinical syndrome with electroencephalographic manifestations of the complex spike and wave 3 c/s. type can occur in many patients after the age of 15 and up to the age of 40, which fact is in complete disaccord with the classical idea of Petit Mal epilepsy good prognosis after puberty.

Uma revisão crítica do conceito, das formas clínicas, das teorias patogênicas relativas à síndrome de Guillain-Barré é feita preliminarmente, com finalidade de situar o ponto de vista dos autores em relação às idéias que encontraram na literatura, por vêzes bastante divergentes. A seguir, uma revisão relativa ao comprometimento dos nervos cranianos nos casos publicados veio mostrar que o nervo facial é o mais freqüentemente atingido, sendo bastante mais raro o comprometimento dos nervos motores oculares ou dos nervos bulbares. São relatadas 7 observações de casos de síndrome de Guillain-Barré com dissociação albumino-citológica no líqüido cefalorraqueano e evolução favorável para a cura em tempo relativamente curto, nos quais a lesão dos IX e X nervos cranianos foi constante. Êste acometimento foi isolado em 2 casos (em um dêles tendo sido também lesado o XI nervo), associada a outros nervos cranianos não bulbares em 4 casos e à paralisia de membros em 5 pacientes. Particular atenção merece o fato de estarem estas 7 observações incluídas em uma casuística de 18 casos de síndrome de Guillain-Barré, 6 dos quais observados no Serviço de Neurologia da Escola Paulista de Medicina em um curto período de 18 meses. Sua alta incidência contrasta, pois, com o que é habitualmente assinalado na literatura.

The ideas found in the medical literature about clinical and pathological aspects concerning the Guillain-Barré syndrome are varied; the authors try in this paper to give their opinion on the subject. As far as the cranial nerves are concerned, the literature shows that the VIIth is doubtless the more frequently injured; the oculomotor and bulbar nerves are seldom damaged. This study was done in 7 patients selected from 18 cases with Guillain-Barré syndrome in the Serviço de Neurologia da Escola Paulista de Medicina. All 7 presented an albumino-cytologic dissociation in the C.S.F., a swift recovery towards cure and envolvement of the IXth and Xth nerves. One case presented isolated lesion of the IXth and Xth nerves; one case, involvement of the IXth, Xth and XIth nerves; four cases, associated lesion of the IXth, Xth and others than bulbar nerves; four cases, paralysis of the limbs besides involvement of the cranial nerves. The authors call attention to high incidence of the bulbar form of the Guillain-Barré syndrome in their material, in contrast with what has been reported in the literature (7 bulbar cases out of 18 Guillain-Barré syndrome patients).

Os autores descrevem a evolução dos conhecimentos sôbre a meningoen-cefalite produzida pelo Criptococcus neoformans, analisando as dificuldades anteriormente havidas para o diagnóstico em vida, as quais foram superadas depois que se usou rotineiramente a pesquisa do cogumelo no LCR pelo método de coloração de tinta da China e pela cultura. Assinalam, a seguir, o aparecimento do Amphotericin B, novo antibiótico fungicida que veio modificar o prognóstico desta afecção. Apresentam sua experiência com 14 casos de meningite por criptococos diagnosticados em vida e referem pormenorizadamente 2 casos tratados com o Amphotericin B. O primeiro, de paciente portadora desta afecção, evoluindo de maneira crônica, com períodos de exacerbação que melhoram nitidamente com o Amphotericin B e que está com uma sobrevida de 20 meses. O segundo, de paciente portadora de forma aguda desta afecção que teve cura clínica e está com LCR absolutamente normal, com seguimento de 11 meses. Em ambos os casos foi usada a via endovenosa, sendo feitas séries de 10 injeções, cada uma de 50 mg de Amphotericin B em 500 ml de sôro glicosado a 5%. No primeiro caso foram feitas 4 séries e no segundo apenas duas. Não foram registradas reações colaterais de importância. Os autores terminam considerando o Amphotericin B como um elemento que veio tornar muito mais favorável o prognóstico desta afecção até então mortal.

The authors made a review of the diagnostic difficulties in meningoencephalitis by the Criptococcus neoformans, in vivo, today easier by special methods such as China ink and culture in the CSF. From their diagnosed 14 cases, 2 have been treated by Amphotericin B. The first was a chronic case with acute episodes which were less severe when Amphotericin B was used. This case has been alive for 20 months. The second case was an acute one with clinical and spinal fluid normalization and has a follow-up of 11 months. In both cases Amphotericin was used intravenously (50 mg in 500 ml of a solution of glycose at 5%) in the first case 4 series and in the second case 2 series. There were no complications. The authors consider that the use of Amphotericin B has given those cases a better prognosis.

Com a finalidade de conhecer os elementos úteis que o EEG poderia trazer para o diagnóstico da forma clínica da cisticercose encefálica, foram reunidos 118 casos desta afecção, com diagnóstico confirmado pela verificação cirúrgica, pelo exame do liqüido cefalorraqueano (presença de leucocitose, eosinofilia e reação de desvio de complemento positiva) ou pela verificação radiológica de cisticercos calcificados. Os resultados electrencefalográficos foram analisados particularmente visando os dados que pudessem informar sôbre existência de processo difuso envolvendo o parênquima nervoso dos hemisférios cerebrais, ou a existência de focos epileptógenos ativos, ou ainda, sinais de sofrimento do parênquima em conseqüência da hipertensão intracraniana. Êstes resultados foram estudados separadamente no grupo dos casos com síndrome clínica da convexidade cerebral, com a presença ou não de síndrome convulsiva e no grupo dos casos com síndrome clínica de base e fossa posterior. Além disso os resultados electrencefalográficos foram estudados comparativamente no grupo de pacientes com cisticercos não calcificados, assim como também foram estudados, comparativamente, em grupos de pacientes com síndrome inflamatória verificável pelo exame do líqüido cefalorraqueano e no de pacientes com o liqüido cefalorraqueano normal. Êstes resultados, projetados nos quadros 1 e 2, permitiram conclusões de algum interêsse clínico, significativas para a importância do exame electrencefalográfico na avaliação dos processos patológicos encefálicos decorrentes da neurocisticercose.

The present study has the purpose of showing the possible value of the EEG in the diagnosis of brain cysticercosis. The diagnosis of cysticercosis was based on (1) radiological calcification, (2) characteristic spinal fluid findings (increase of cells, increase of eosinophils and positive test for cysticercosis) and/or (3) neurosurgical findings. The total number of cases was 118 (14 verified by surgical approach, 35 diagnosed by X ray examination and 42 by the spinal fluid examination) : in 16 cases there were association of surgical and spinal fluid positive findings; in 4 cases there were surgical findings and X ray positive findings; in 7 cases there were spinal fluid and radiological positive findings. The surgical cases were mostly of cysticercus of the posterior fossa because of the spinal fluid blocking that asks such therapy. The patients were divided according to the localization of the cysticercus (1) on the cortical surface, (2) at the base of the brain and the posterior fossa, and (3) diffuse cysticercosis. The localization of the cysticercus was possible by the evaluation of the clinical signs, the radiological calcification or the neurosurgical finding of the cysticercus. The EEG records were analysed according to the changes possibly due to the lesion caused by the cysticercus (chronic and diffuse meningo-encephalitis of the brain surface, arachnoiditis of the base and of the posterior fossa, inflammatory reaction inside the fourth ventricle, with subsequent spinal fluid blocking and intracranial hypertension). The analysis showed: 1 - Focal paroxysmal changes have indicated the great incidence of epileptic seizures in these patients; 2 - δ waves were more frequent when the lesion was located in the posterior fossa. The meningo-encephalitis on the cerebral surface did not show EEG signs of acute brain involvement; 3 - θ waves were seen very seldom and were present only on those patients with signs of basal or posterior fossa involvement (due to intracranial hypertension probably) due to involvement of mesencephalic structure; 4 - The normal EEG was very rare in patients with cerebral cysticercosis and did not give any information regarding the localization of the cysticercus; 5 - Changes on background activity (disorganization or discrete slow waves) have been noticed in all groups of patients; 6 - In patients with diffuse cerebral cysticercosis the EEG changes (disorganization on background activity, slow waves or signs of focal activity) did not show striking difference from those patients with localized cerebral cysticercosis; 7 - The calcified cysticercus on the cerebral surface (chronic cysticercosis) was coincident more often with focal activity on the EEG, than on the group of not calcified cysticercus (recent, cysticercosis); 8 - The incidence of pathological EEG was the same on both groups (calcified and non calcified cysticercosis). The EEG on the last group showed very often δ waves.

Os autores, que vêm fazendo exames eletrencefalográficos sistematizadamente em casos de abscessos cerebrais desde 1951, relatam sua experiência, ressaltando os elementos que o EEG proporciona para o diagnóstico e prognóstico desses processos. O material que apresentam é de 22 casos (20 com EEG pré-operatório, 17 dos quais com seguimento eletrencefalográfico pós-operatório, e 2 nos quais só foi feito EEG pós-operatório) com diagnóstico confirmado pela ar-teriografia e pela intervenção cirúrgica. Todos foram submetidos a trata- mento cirúrgico e antibiótico, sendo o seguimento clínico-eletrencefalográfico a partir do 30º dia após a intervenção cirúrgica. No grupo dos pacientes com EEG pré-operatório foram encontradas alterações difusas do traçado em 20 casos (100%) e alterações focais consistentes em ondas delta 0,5 a 3 c/s, potencial de 400 a 500 mV (19 casos), depressão focal do ritmo de base (11 casos), foco epileptógeno (2 casos). As ondas delta bastante lentas e a depressão focal do ritmo de base constituem elemento de valor para o diagnóstico, particularmente quando interpretados em consonância com a clínica. No grupo de pacientes seguidos com exames clínicos e eletrencefalográficos sistemáticos, por um período que variou de 1 a 60 meses, foram encontrados sinais de foco convulsiógeno ativo em 10 dos 17 pacientes observados. Na opinião dos autores êste índice anormalmente elevado está em consonância com a freqüência de epilepsia pós-abscesso cerebral. O tempo que decorreu entre a operação e o aparecimento do foco ativo variou de 1 até 25 meses. Dêsses 10 pacientes com foco ativo e com epilepsia clìnicamente comprovada, sòmente 2 tinham foco anteriormente ao processo de "cura" do abscesso. Os autores discutem êsse problema e pensam ser os processos de cicatrização - processos crônicos -- os responsáveis por tais manifestações clínico-eletrencefalográficas. Ainda neste grupo chamam atenção para o fato de que em sòmente 4 pacientes o EEG continuou a se manter normal durante todo período de observação, sendo que 2 outros tiveram EEG normal por 5 e 15 meses, respectivamente, e, mais tarde apresentaram foco ativo. Ao lado dêstes focos epileptógenos, em 3 pacientes havia também sinais de sofrimento do parênquima nervoso (ondas delta) 1 a 3 meses depois da intervenção cirúrgica (casos com convulsões reiteradas ou ainda com sinais do abscesso em evolução). Em 6 casos havia certa depressão focai pós-operatória no EEG; em 4 havia alterações frustras do ritmo de base, alterações estas de tipo cicatricial e sem correlação clínica correspondente. Concluem os autores que o EEG constitui excelente método auxiliar no diagnóstico de abscessos cerebrais e, principalmente, elemento muito útil no prognóstico dos casos tratados, quer evidenciando desaparecimento dos sinais agudos de comprometimento cerebral, quer fornecendo precocemente sinais da formação de foco convulsiógeno ativo, possibilitando a instituição precoce de terapêutica anticonvulsiva.

The authors have made electroencephalographs studies in cases of cerebral abscess since 1951; these records were always obtained before any neurosurgical treatment and were repeated several times after the surgical approach. The authors call the attention to the important data that the EEG can offer to the diagnosis of cerebral abscess and to the prognosis in patients who were operated on. Twenty-two patients (20 had EEG previously to the surgical treatment, 17 with repeated EEG after the operation and 2 had EEG only after the operation) were clinically and electroencephalographically studied, the diagnosis being confirmed by arteriograms and by the surgical treatment. AH patients were operated on and received antibiotics. In the present paper the EEG changes found during the first month following the surgical treatment were not included. In the group of patients with EEG obtained before the surgical treatment, the authors found difuse changes in the record of the 20 patients (100 per cent), and focal changes consisting mainly by delta waves of 0.5-3 c/s, potential of 400-500 mV (19 cases) focal depression of the basic rhythm (11 cases); epileptogenic focus was found only in 2 cases. The very slow delta waves and focal depression of the basic rhythm represent very important data for the diagnosis, particularly when studied in relation to the clinic data. In the group of patients who had clinical and EEG examinations after the operation, being the EEG records repeated during a period of time from one to 60 months, the authors found signs of active convulsive focus in 10 out of 17 patients. In the opinion of the authors this incidence is very high and it is in accordance with the high frequency of epilepsy following cerebral abscess. The lenght of time between the operation and the onset of the focal activity varied from one to 25 months. Out of the 10 patients with focal activity and with clinical epilepsy, only 2 patients had presented focal activity before to the "healing" of the abscess. The authors discuss this problem and believe that the healing, which is a chronic process, is the responsible for the onset of these clinically and electroencephalographically manifestations. In the same group only 4 patients had normal EEG during all the follow-up; 2 patients had normal EEG during 5 and 15 months, but developed focal activity later on. Other 3 patients had signs of suffering of the nervous tissue (delta waves) from one to 3 months after the operation (patients with convulsive seizures or still with signs of abscess in evolution).. In 6 cases there was slight changes of the basic rhythm, which were due to the healing and with no clinical correlation. The authors conclude that the EEG is a very important auxiliary method for the diagnosis of cerebral abscess and for the prognosis of those cases surgically treated, since it shows disappearance of acute signs of cerebral involvement, or early formation of active convulsive focus, permitting the begining of the anticonvulsive therapy.

Os resultados eletrencefalográficos em 22 casos verificados de afecção cirúrgica da fossa posterior, obtidos com uma rotina de exame detalhado como preconiza Bagchi, são relatados de modo sintético, em quadros comparativos entre dados eletrencefalográficos e neurocirúrgicos. Dessa análise podem-se deduzir as seguintes idéias conclusivas: 1. Dos 22 casos estudados, 9 foram normais e 13 anormais. Entre as anormalidades eletrencefalográficas destacamos: a) surtos de ondas bilaterais e síncronas, substituindo o ritmo de base, de potencial ligeiramente superior ao de base e de freqüência 4 a 7 c/s (ritmo θ) : b) ondas lentas e irregulares, difusas ou localizadas (ondas δ), mas sempre com sensível dispersão temporal em relação às áreas de predominante projeção. 2. As alterações eletrencefalográficas não diferiram em casos de tumores das de lesão de tipo inflamatorio (quadro 1). 3. Os surtos de ritmo 4 a 7 c/s bilateral síncrono não diferençaram afecções da linha mediana das paramedianas (quadro 4). 4. Os casos de EEG normal apareceram preferentemente entre afecções extraparenquimatosas, comparativamente com as de lesão intraparen-quimatosa (quadro 3). 5. Nos casos em que houve nítida lateralização das ondas δ;, o processo era contralateral na fossa posterior (quadro 2). 6. Os surtos de ondas δ difusas apareceram mais freqüentemente nos casos de afecção mediana da fossa posterior (quadro 4).

The authors have analysed 22 cases of verified infratentorial surgical lesions and found: 1. In 9 cases the EEG was normal and in 13 abnormal. The predominant EEG modifications were: outbursts of bilateral synchronous waves, 4 to 7 c/s. (θ rhythm) and δ waves, diffuse or localized, with temporal dispersion in relation to predominant projection areas. 2. The EEG changes did not differentiate the inflammatory lesions from the tumors. 3. The outbursts of 4 to 7 c/s. bilateral synchronous waves did not differentiate the midline lesions from the lateral lesions. 4. The normal EEG was dominant in the cases of extraencephalic lesions in relation to the intraparenchymatous lesions. 5. In the cases of definite localized δ waves the lesions were contralateral in the posterior fossa. 6. The outburst of diffuse δ waves were more frequent in the midline lesions.

O caso apresentado refere-se a uma paciente, observada ininterruptamente desde os 5 anos até aos 14 anos de idade, cuja moléstia evoluiu para a cura clínica completa. O quadro inicial caracterizou-se pelo aparecimento de crises convulsivas de tipo bravais-jacksoniano reiteradas, em menina anteriormente sadia, que havia sido portadora de tênia. A radiografia do crânio foi normal, porém o exame do liqüido cefalorraqueano revelou hipercitose, com presença de eosinófilos em algumas amostras, aumento das proteínas e, mais particularmente, das globulinas, além de positividade da reação de fixação de complemento para cisticercos, possibilitando assim o diagnóstico etiológico. O curso clínico foi acompanhado cuidadosamente com exames clínicos e do líquor cada 6 meses. Foram feitos tratamento geral anticonvulsivante (hidantoinatos e barbitúricos) e terapêutica visando em particular os cisticercos (extrato etéreo de feto macho na dose diária de 1 g, na freqüência de 10 dias por mês, durante um ano, além de ionizações transcerebrais com iodeto de potássio). O desaparecimento das crises fêz-se logo no segundo ano de evolução, com ligeira recidiva em 1948, e os exames do líquor mostraram decréscimo progressivo da pleocitose, normalização das proteínas, negativação da reação de fixação de comple- mento para cisticercos. Por último, a radiografia do crânio, que inicialmente era normal, mostrou quatro cisticercos calcificados. 0 eletrencefa!o-grama, feito em 1953, não evidenciou qualquer foco lesional cerebral con-vulsiógeno ativo. A evolução somática e mental da paciente foi ótima, tornando-se hoje uma moça inteligente, boa estudante, perfeitamente bem integrada no ambiente familiar e social em que vive.

The authors make general considerations about the clinical picture and prognosis of cerebral cysticercosis and relate a case with favorable evolution for 10 years, which had a complete cure. The patient, a 5 year old girl, was first seen due to repeated Jack-sonian seizures. She had been healthy but had had tape-worm. Craniogram was normal, and spinal fluid examination revealed hypercytosis, with eosinophils, increased proteins, particularly the globulins, and positive reaction for cysticercosis. The patient was carefully re-examined during these 10 years, and clinical examinations and spinal fluid tests were performed every six months. She received general anti-epileptic treatment (hidantoinate and barbiturate) and specific treatment for cysticercus. The seizures disappeared after 2 years of treatment, with a slight recurrence in 1948, and the spinal fluid examinations showed progressive decrease in the cell count, normalization of proteins and the reaction for cysticercus became negative. The craneogram, which was normal beforei now showed four calcified cysticercus. The EEG made in 1953 showed no evidence of focal lesion. The somatic and mental development of the patient was normal.

Os autores fizeram revisão do estudo clínico e eletrencefalográfico de 1.000 pacientes com manifestações clínicas do tipo epiléptico, selecionados entre 4.700 casos estudados. Em todos os casos foi obtida anamnese detalhada sobre o tipo de crise, os antecedentes pessoais (em particular antecedentes obstétricos, traumas ou moléstias outras afetando o encéfalo) e heredo-familiares, assim como a idade de início de suas perturbações. Cumpre assinalar que a primeira convulsão foi considerada como início da moléstia, mesmo quando entre ela e as demais tivesse havido um intervalo de anos. Paralelamente, em todos os casos foram feitos exames clínico, neurológico e psiquiátrico, e, em grande número deles, exames de liqüido cefalorraqueano e radiográfico do crânio (craniograma simples, pneumencefalograma e arteriograma). As manifestações clínicas, classificadas segundo o critério de Penfield e colaboradores, foram comparadas com os resultados obtidos pela eletren-cefalografia (simples ou ativada) e finalmente projetadas em gráficos e quadros. Estes foram catalogados separadamente segundo os grupos de idade de 11 a 20 anos, de 21 a 35 anos, e de 36 e mais. Os resultados clínicos e eletrencefalográficos, assim como a comparação entre uns e outros, permitem destacar os seguintes fatos: 1. No total dos pacientes o eletrencefalograma mostrou alterações de tipo lesional em 36,8%, alterações de tipo endógeno em 32,5% e não evidenciou alterações de tipo epiléptico em 30,7%. 2. Os pacientes portadores de alterações do tipo lesional assim se distribuíram segundo os grupos de idade: 39,8% no primeiro grupo (11 a 20 anos), 36,7% no segundo (21 a 35 anos) e 32,30% no terceiro (36 e mais). 3. Êstes mesmos pacientes assim se distribuíram segundo a idade do início da moléstia: 53,9% no grupo de 0 a 10 anos, 31% no grupo de 11 a 20 anos, 29,1% no grupo de 21 a 35 anos e 31,8% no grupo de mais de 36 anos. 4. Os pacientes portadores de alterações do tipo endógeno assim se distribuíram segundo os grupos de idade: 42,25% no primeiro grupo, 33,75% no segundo e 16% no terceiro. 5. Tais pacientes assim se distribuíram segundo a idade do início da moléstia: 30,2% no grupo de 0 a 10 anos, 41,5% no grupo de 11 a 20 anos, 31,9% no grupo de 21 a 35 anos e 8,5% no grupo de 36 anos e mais. 6. Os pacientes em que o EEG nada revelou assim se distribuíram segundo os grupos de idade: 17,94% no primeiro grupo, 29,50% no segundo e 51,70% no terceiro. 7. Esses pacientes, segundo a idade do início da moléstia, assim se distribuíram: 15,9% no grupo de 0 a 10 anos, 27,5% no grupo de 11 a 20 anos, 39% no grupo de 21 a 35 anos, e, finalmente, 59,7% no grupo de 36 anos e mais. 8. O tipo de distúrbio eletrencefalográfico, assim como a topografia das alterações focais, quando presentes, coincidem, em elevada percentagem de casos, com o tipo das manifestações clínicas dos pacientes. 9. As crises de tipo bravais-jacksoniano, em discordância com os demais tipos de crises focais, apresentou elevada proporção de casos com EEG negativo (36 em 91 casos). As crises de epilepsia temporal mostraram 10 casos negativos num total de 132, e as demais crises motoras late-ralizadas evidenciaram somente 18 num total de 125 casos. 10. A crise do tipo GM foi a que mais apresentou EEG negativo (236 num total de 572 casos). A crise de tipo PM confirmou integralmente o diagnóstico de fator endógeno predominante (43 sobre 44 casos). 11. As crises de tipo temporal apresentaram, em grande proporção de casos, distúrbios de tipo lesional no EEG (118 num total de 132 casos) e, em particular, tais distúrbios lesionáis foram de tipo focal nos lobos temporais (86 num total de 118 casos). 12. As demais crises motoras lateralizadas evidenciaram igualmente, em elevada proporção, distúrbios de tipo lesional no EEG (88 num total de 127 casos). 13. A presença de epilepsia em parentes até o terceiro grau mostrou coincidir com a maior proporção de casos de epilepsia endógena (90 num total de 219 pacientes). 14. Em reverso, os sinais neuro-psiquiátricos de afecção orgânica cerebral coincidiram, em elevada proporção, com a presença de distúrbios de tipo lesional nos traçados eletrencefalográficos (93 num total de 120 pacientes) . 15. A ativação pelo sono barbitúrico tem sido feita nos casos em que o exame simples ou ativado pela hiperpnéia nada revelara ou com finalidade de melhor identificar distúrbios frustros. Num total de 202 casos em que foi empregada, conseguiu positivar elementos em 65. Entre os casos em que a ativação pelo sono foi positiva sobressaem os de crise temporal, nos quais foi elucidativa em 37, e negativa somente em 9. 16. A ativação pelo metrazol, usada de rotina mais recentemente, foi feita em 55 pacientes, com o mesmo critério. Ela conseguiu positivar o diagnóstico em 37. 17. E' de salientar que, dos 307 pacientes em que o EEG não evidenciou característicos de tipo epiléptico, percentualmente o maior número estava entre os de idade superior a 35 anos. Isto faz pensar na possível existência de outros fatores correlativos (intoxicações crônicas, anóxia por artériosclérose cerebral, hipoglicemia, etc.), que não os lesionáis cerebrais, na gênese de seus distúrbios paroxísticos.

The authors made the review of a thousand of patients with clinical syndrome of epilepsy, in whom clinical and EEG studies were obtained. These one thousand cases were selected among 4,700 cases of epileptic patients with EEG diagnosis. From all cases, detailed history of the type of seizure, of past history (particularly obstetrical history, traumatic lesions and other cerebral lesions), of familial history, and of the beginning of convulsive seizures, have been obtained. In every case the onset of the disease was considered as the first convulsive seizure, even when between the first and the next there was a large period of time. In every case clinical, neurological and psychiatric examinations were obtained. In many of the cases spinal fluid and radiological (craniogram, pneumoencepbalogram and arteriogram) examinations were performed. The clinical manifestations were classified according to Penfield and col. These clinical features were compared with the EEG records (in 202 cases with barbiturate sleep and in 55 cases with metrazol), and projected in graphs and tables. In these the patients were classified according to age in three different groups (from 11 to 20 years of age, from 21 to 35, and with more than 36 years of age). From this study, the authors call the attention to the following data: 1. The EEG showed changes of lesional type in 36.8 per cent of the cases, of endogenous type in 32.5 per cent and did not show epileptic changes in 30.7 per cent. 2. Patients with lesional type of EEG could be classified according to age in the following manner: 39.8 per cent in the first group (from 11 to 20 years of age), 36.75 per cent in the second group (from 21 to 35 years of age) and 32.30 per cent in the third group (with more than 36 years of age). 3. The same patients could be classified according to age of the first seizure: 53.9 per cent in the group from zero to 19 years, 31 per cent in the group from 11 to 20 years, 29.1 per cent in the group from 21 to 35 years, and 31.8 per cent in the group with more than 36 years. 4. Patients with endogenous changes in the EEG were classified according with the age in the following manner: 42.25 per cent in the first group, 33.75 per cent in the second group, and 16 per cent in the third group. 5. These patients were distributed according to age of the first seizure: 30.20 per cent in the group from zero to 10 years, 41.50 per cent in the group from 11 to 20 years, 31.9 in the group from 21 to 35 years, and 8.5 per cent in the group with more than 36 years. 6. The patients with non epileptic changes in the EEG could be classified: 17.94 per cent in the first group, 29.5 per cent in the second and 51.7 per cent in the third. 7. These patients were classified according to the first seizure in: 15.9 per cent in the group from zero to 10 years of age, 27.5 per cent in the group from 11 to 20 years of age, 39 per cent in the group from 21 to 35 years of age and 59.7 per cent in the group with more than 36 years of age. 8. The EEG changes and the topography of these changes, when they were present, were coincident with the clinical syndrome in high percentage. 9. Bravais-Jacksonian seizures had negative EEG in high percentage of cases (36 in 91), in discordance with the other types of focal seizures. Temporal seizures were negative in 10 among 132 cases, and the other motor seizures with lateralization were negative in 18 among 125 cases. 10. GM seizures were the type with higher incidence of negative EEG (236 among 572 cases). PM seizures indicated the diagnosis of endogenous lesion (43 in 44 cases). 11. Temporal seizures presented lesional type of changes in the EEG in high percentage of cases (118 among 132 cases). These lesional type of changes were of focal type in temporal lobes in 86 among 118 cases. 12. The other types of motor seizures with lateralization showed high incidence of lesional changes in the EEG (88 among 127 cases). 13. The incidence of epilepsy among relatives was higher in lhe group of endogenous epilepsy (90 in 219 cases). 14. The neuro-psychiatric signs of cerebral organic diseases were coincident with lesional type of changes in the EEG in high incidence (103 among 130 patients). 15. The barbituric sleep was used when the routine EEG or the EEG with hyperventilation did not show evident changes. In this way it was possible to bring out positive findings in 65 among 202 cases. The barbituric sleep was helpful in 65 cases of temporal seizures and negative in 9. 16. The metrazol was used in 65 patients, with the same criteria. It was helpful in 46. 17. The majority of the 307 patients with EEG showing no epileptic patterns was older than 35 years. This probably indicates the existence of other co-factors (as chronic intoxications, anoxia due to cerebral arteriosclerosis, hypoglycemia, etc.), when cerebral lesions are not present, in the genesis of paroxistic disturbances.

Radiotherapy in high doses has been used in cases of symptomatic epilepsy with the purpose of to act against the focal epileptic activity, as coadjuvancy to the common medical treatment. Patients with clinical manifestations of epilepsy in whom convulsive foci were demonstrated in the EEG, have been selected; these foci have been recognized as well localized and well circunscribed, and in all them the etiology has been the same (atrophic lesions), according to the clinical and radiological (craniogram, pneumoencephalogram and arteriogram) examinations. The purpose of a so homogenous group was to study the results to be obtained in similar conditions. Twenty patients have been selected from a group of forty-eight, because it was possible to obtain a good follow-up for at least three months in each case. In all cases, a medical treatment (barbiturate plus hidantoi-nate) has been used in uniform manner, with the purpose of avoiding influence on the judgement of the value of radiotherapy, for it was impossible to interrupt the drug therapy. Radiotherapy has been used in high doses over the epileptic lesion, which had been localized by the EEG. Two different techniques were used; in both 200 kv, 0.5 mm. filter of Cu were employed. Fourteen patients were irradiated in four different areas, of 4 cm. in diameter each one; they received 150 r daily, 2 areas by day, performing an average total of 3,000 r. In the other 6 cases the technique of kinetic convergent radiotherapy was employed, using the Siemens apparatus; each patient received, through a cutaneous area, an average doses of 3,000 r into the focus and 2,000 r in the skin; they received from 100 r to 150 r in the focus daily. Studying the twenty cases individually, there was marked EEG improvement in 4, relative improvement in 8 and no change in 8; there was marked decrease in the number of seizures in 8, relative decrease in 10 and no change in 2; the mental status was markedly improved in 7, relatively improved in 6 and not changed in 7. The authors call attentiori to the following points: a) Radiotherapy seems to act directyl over the focal electric activity, for there was marked improvement in 4 cases, and relative improvement in 8 cases, immediately after its use; in 2 cases there was exacerbation of the focal activity later; b) In all cases there was decrease in the number of seizures just after radiotherapy; it was not possible, however, to associate this improvement only to radiotherapy, for there was increase of seizures in 2 patients when medical treatment was stopped; c) There was improvement of mental status in 13 cases, although it is important to remember that there was also improvement of the cerebral physiology due to the decrease in number of seizures and improvement of the emotional status of the patient related to their better clinical conditions; d) There was no relation between the number of seizures and focal activity evidenced by the EEG; e) There was no relation between the intensity of cerebral focal activity and the mental status of the patient. The authors conclude: 1) Radiotherapy in high doses decrease the epileptic cerebral focal activity; 2) It is impossible to affirm that the clinical improvement is due to radiotherapy only; 2 patients had increase of focal activity far away from radiotherapy, and 2 others presented increase in the number of seizures when medical treatment was discontinued.

Analisando os casos publicados sôbre o assunto, e apresentando um material próprio constituído de 5 casos de aneurismas arteriovenosos, um de aneurisma da artéria silviana e 3 de malformação de Sturge-Weber-Dimitri, estudados clínica, eletrencefalográfica e radiològicamente (craniograma simples e arteriografia cerebral), o autor procura mostrar a importância dos resultados eletrencefalográficos para o diagnóstico exato e para orientação da terapêutica etiológica. Com os elementos assim coligidos conclui: 1) Nos casos de aneurismas arteriovenosos, o EEG deu sinais de diagnóstico focai decisivo em 4, sendo que em 2 levou à arteriografia pacientes que tinham tido uma e duas crises convulsivas, respectivamente, possibilitando, assim, diagnóstico etiológico e terapêutica cirúrgica; em um caso orientou o diagnóstico exato de um paciente de 55 anos, que há 25 anos era tido como epilético; em um caso sòmente não deu sinais de anormalidades, tratando-se de pequeno aneurisma arteriovenoso situado entre circunvoluções parietais. 2) No caso de aneurisma da artéria silviana, situado na base do cérebro, o EEG mostrou somente os distúrbios difusos e bilaterais conseqüentes à hemorragia meníngea. 3) Nos 3 casos de malformação de Sturge-Weber-Dimitri, o EEG demonstrou alterações de tipo depressão de atividade elétrica cerebral correspondente à malformação calcificada; em um dêstes casos mostrou ní- tido foco epileptógeno frontal, explicando perfeitamente sintomatologia de convulsões de tipo bravais-jacksoniano e hemiparesia, independentemente da calcificação tipo angiomatosa, de situação occipital.

Reviewing the cases published in the literature and studying his own material (3 cases of Surge-Weber-Dimitri's disease, one case of aneurysm of the medial cerebral artery and 5 cases of arteriovenous fistula) by the clinic, the EEG, the roentgenogram and the arteriogram, the author shows the importance of the EEG record in the establishment of correct diagnosis and in the choice of treatment in these cases. The author concludes: 1) In the cases of arteriovenous fistula, the EEG showed focal signs in 4 cases; in 2 of them, the EEG record demonstrated the necessity of arteriograms, for the patients have had one and two seizures, respectively, bringing out the possibility of etiological diagnosis and surgical treatment. In another case, the EEG gave orientation for the diagnosis; the 55 year-old patient had been considered as an epileptic for 25 years. In the fifth case (the aneurysm was small and located between parietal convolutions) the EEG did not show focal signs. 2) In the case of aneurysm of the medial cerebral artery, located in the base of the brain, the EEG revealed diffuse and bilateral signs, probably due to the previous subarachnoid hemorrhage. 3) In the 3 cases of Sturge-Weber-Dimitri's disease, the EEG showed records with depressed electrical activity, corresponding to the calcified areas. In one case the EEG also revealed the presence of a frontal focus which explained very well the Bravais-Jacksonian seizures and the hemiparesis, independently of the occipital angiomatous calcification.